The faster the food delivery comes, the faster the Amazon box arrives, the faster the doctor calls back -- the better.

So, many people fall into the trap of believing that live videoconferencing is the preferred form of telemedicine. If "now is better," a live videoconference with a colleague or your provider is best.

The truth is that hybrid store-and-forward telemedicine has been found to have profound advantages over videoconferencing telemedicine models. And it may not be for the reasons you think.

An interesting model of “integrated behavioral healthcare” is advancing some interesting findings around the divide between asynchronous models and videoconferencing models. A study published recentlylooks at a program in which a team of primary care providers (PCPs) and behavioral health providers, work together in the primary care setting. The intention is to explore whether, for psychiatric use, it's helpful or necessary to have synchronous communication (like videoconferencing.) Half of participants are randomly assigned to an asynchronous model of consultation while the other half are assigned to a videoconferencing model.

Initial summary data and case findings of a 5-year study of a randomized controlled trial of an asynchronous model compared with a videoconferencing model seems to be indicating that the asynchronous model works equally well, but with less cost and lower administrative burden.

Live videoconferencing is effective, but can be augmented and sometimes replaced by the more efficient, less costly, and more time respectful Store and Forward.

As the study authors summarize, "When PCPs are able to combine direct care with synchronous and asynchronous consultation options, a multitude of care possibilities become available, enabling a more flexible and stepped care structure.”

The study acknowledges that not only is asynchronous care less challenging logistically, but it is also a much more data-rich method than synchronous (like videoconferencing) approaches.

I think this is an exciting contribution to our field's ongoing exploration of the best role for telemedicine in the healthcare system. As we discussed in yesterday's post, the healthcare field will deeply benefit from breaking down the preconceptions of what telemedicine can look like, and what the benefits really are of on-demand communication. It's our responsibility to think creatively about what programs can look like, take a holistic view of effects and costs, and be thoughtful about what the best technology for support.